Within the last few years the marriage of the so-called minimal invasive surgery (i.e. laparoscopic surgery, characteristically using straight thin and rigid instruments) and endoscopy (i.e. interventions inside the hollow organs through the natural orifices characteristically with flexible instruments) has resulted in the birth of the NOTES (Natural Orifice Translumenal Endoscopic Surgery) technique, which has been recently applied mainly in experimental surgery. The desired advantage of the NOTES comparing to laparoscopic surgery (surgery through small abdominal incisions) includes the further minimization of surgical intervention and operative risk in the treatment of certain diseases. However, to perform NOTES intraabdominal interventions (e.g. removal of the gall bladder, appendix, ligation of the ovarian tubes, etc.) it is necessary (i) to insert a flexible endoscopic system e.g. through the mouth, vagina or the rectum into the abdominal cavity via the hollow organ's wall, (ii) to perform the surgical intervention with the device in the abdominal cavity, (iii) to remove the necessary tissues or organs out of the body, (iv) to safely close the artificially created opening on the hollow organ's wall at the end of the procedure, and (v) to remove the device-system through the natural orifice.
According to current research there is no device or device-system available, which would be able to perform alone all steps of the aforementioned interventions (i.e. the whole NOTES or SPLS). It must be noted that the currently available devices, which can perform only a single part of the whole procedure, are still not enough reliable, and in most of the cases their usages are difficult and awkward. It is still a challenging problem to have these instruments fixed inside the abdominal cavity, to have them arranged in a triangular pattern (the so-called triangulation) to achieve their better coordination and cooperation, and to safely close the artificially created opening on the hollow organ's wall, respectively. The above mentioned difficulties may lead to severe, occasionally to life threatening complications, e.g. injury of vital organs, bleeding or peritonitis.
There are plenty of various devices developed for the NOTES interventions. Their properties usually evolve as a result of the various combinations of laparoscopic and endoscopic features.
One of the most promising recent solutions is described in the US/2007/086079 patent application. According to this description, the flexible instruments are inserted into the abdominal cavity through the working channels of an endoscopic tube like device. The inner end of this endoscopic device is controlled by its outer end, utilizing traditional technical solutions. The inner ends of the instruments inserted into the endoscopic tube-like device are also controllable by a bulky device, which is attached to the outer end of the endoscopic tube-like device. However, the disadvantage of this solution is that the fixation of the inner ends of the instruments and the endoscopic tube-like device, and the proper triangulation of the instruments remain unsolved. Another drawback is that the device controlling the inner ends of the instruments is relatively bulky, and in case of a new instrument insertion it requires additional assembling, and furthermore because of its relatively large size it needs extended room when more than two instruments are inserted. Additionally, this solution does not follow the well prepared and reliable laparoscopic maneuvers but requires new kind of maneuvers. Its main problem is not concerned with the necessity to learn a new technique but with the fact that when any complication occurs during a procedure, it is advantageous to solve it with the laparoscopic technique. The two different techniques may disturb each other when they are used simultaneously.
Another innovative idea is described in the WO/2008/131046 patent application. This instrument is a simple modification of the traditional laparoscopic instruments: both the head and the handle of the instrument are bendable simultaneously toward each other. The bending of the handle controls the synchronous bending of the head by wires. In fact, this instrument was developed primarily for the SPLS (Single Port Laparoscopic Surgery), where usually the navel is used to enter the abdominal cavity. This new SPLS method is considered to be an alternative to the NOTES technique. Actually the SPLS is a variation of laparoscopy. A major drawback of this solution is that the movements of the inner and outer ends of the cited instrument are contrariwise as compared to the conventional laparoscopic instrument, and this is really difficult to learn. The relative congestion of the instruments in the above mentioned ideas is another disadvantage, which could jeopardize the effectiveness and safety of these procedures.